Corrective Pigment Camouflage: Part 2 of 3

This information is part 2 in a 3-part series.

This selection will consist of distinguishing skin undertones, patch and sensitivity tests, proper equipment, pigment, technique and time frame from application to application.

Pre CPC and Scar Relaxation

A 33-year old patient has contractures extending from the tip of the left ear, over the zygomatic, to the filtrum. Post-burn scar contractures of cheek and mouth area, including hyper-and hyper pigmented regions. This photos shows her before Corrective Pigment Camouflage (CPC) and Scar Relaxation treatments.


Post CPC and Scar Relaxation

Patient chose to receive Corrective Pigment Camouflage instead of a radial forearm flap procedure because of the scarring and recovery time involved. Photo shows patient 6 months after CPC was applied to facial areas. Skin tones now integrate into one another.

Natural pigments are classified as melanin. Melanin is comprised of molecules that are capable of reflecting color. The perceived color of our skin is caused by the reflection of light on our skin, known as light refraction. Neuromelanin (brown black), and Phomelanin (yellow red) are two types of melanin.

Melanocytes are the main cells responsible for the color of our eyes, hair and skin. These cells are located in the basal layer of the epidermis. They synthesize red, brown and yellow melanin biochromes (melanin) and are the major determinants of skin color. The biochromes include: carotene (which incorporates the yellow or yellow-orange color into the skin), oxygenated hemoglobin (which incorporates the red color into the skin) and deoxygenated hemoglobin (which incorporates the blue color in the skin). Normal differences in our skin colors are determined by the intensity of the pigmentation and melanin production.

The basic undertones of our skin do not change. Certain conditions may affect the appearance of the skin of a patient. Client consultation, as well as each application visit, should include updated information on recent illness, changes in diet and medication, fatigue, excess smoking and alcohol consumption, along with the use of self-tanning creams, tanning beds and natural sun tanning.

I use two easy and reliable methods of determining skin undertones. ‘Color With Style’ by Donna Fujii is one of the best reference publications I have found. I also use an invaluable tool called the ‘Color Undertone Chart’ from IIPC. It has 4- 8×10 pockets of color that represent pink, yellow, olive and blue skin undertones. Actual beads of pigment color are dropped on a sheet of white paper and then laminated. These color charts are then inserted into the cool/warm pockets of simulated skin undertones. This is the best method for determining how the color will look once it is implanted and reverted back to its natural state in the skin. The charts are made to slide in and out of the pockets to check on the difference each skin undertone has on the pigment color. These charts will help you to develop a keen eye in determining the underlying harmony existing between the skin, eyes and hair. This system is based on ‘Munsell Color Theory.’ Munsell recognizes that color has three dimensions: Hue, Value and Chroma. A thorough analysis of skin undertones is vital in order to successfully custom blend colors on an individual patient basis. The reference book, ‘Permanent Cosmetics A to Z,’ gives in-depth definitions of the proper protocol for CPC procedures with reference to proper utilization of pigment and needle cluster application.

For accurate color results always patch test and sensitivity test directly into the procedural area. Using either a rotary or a coil machine and a 3 round needle, we insert 7-8 implants of iron oxide pigments superficially into the epidermal tissue. To ensue optimal outcome, it is always wise to perform several different color tests for variegated skin tones. Modify color value as needed. Pigment should be placed into the epidermis (for minimum color retention) that will be sloughed off within 3-8 weeks. We utilize this method of application to discourage inappropriate color choices. Even if I know I have a valid color match for a patient’s skin tone, I will still patch test them and let the area heal for 4-8 weeks. Changes or additions in any medications may alter the chemistry of the body rendering your initial patch and sensitivity test inaccurate. Before inserting pigment, take patient outside into the natural daylight. This will enable you to have optimum visual clarity, which is the best perception of the pigment color you have chosen. The next best type of lighting is daylight bulbs, vita-lights or true white lights.

When the patient returns 4 – 8 weeks post consultation, evaluate results. Appropriate color choices and necessary changes can now be made. Patient and technician should thoroughly discuss healed colors from patch and sensitivity testing. Does the color look too ash? Too pink? Does it blend into the surrounding tissue? When patient and technician agree on the most flattering skin tones with consideration to color chroma, hue and value, application may begin. If you cannot agree on matching tones, you may repeat patch test application again.

After every application the pigment will revert back to its original state, dry. Only then will we have accurate final color results. All permanent cosmetic and CPC procedures are combinations of pigment color plus the patients skin undertones. These two factors will yield your final color result.

For all CPC applications we use an 8-wrap coil machine. Using a coil machine, you will achieve a smoother and more consistent application. Most rotary machines do not have sufficient power to penetrate scar tissue. Proper application is best achieved with needle groups of 14 rounds and 6 flats. Scar tissue may be void of pores, hair follicles, and glands. This tissue consists mainly of collagen fibers and can be very difficult to penetrate. Different techniques should be utilized according to tissue density. The same techniques used in lipliner, eyeliner and eyebrow hair simulation may be used on grafted tissue that is not scarred. Tissue that has extensive contractures will be very difficult to penetrate.

From previous experience on burn survivors with extensive scar contractures, I have found that patients will experience scar relaxation through repeated perforations with the coil machine. Whether you use metal or plastic tubes for your coil machine, make sure to use them for camouflage application only. Also, you need to mark the tubes for light or dark camouflage work. (You would not use the same tube on a Caucasian and an African-American.) Dark colors can leach into plastic tubes when autoclaved. We prefer to use white disposable tubes for CPC application. This will ensure us that we will never use a tube that could be possibly contaminated with prior use of darker colors. Remember disposable tubes are just that – disposable.

Use products, including pigments and equipment, with high quality. Purchase these products from companies with solid reputations that have strong track records. Ask other technicians for recommendations. There is a plethora of products created for cosmetic tattooing. The base ingredient of most pigments is generally the same. We suggest only using cosmetic grade iron oxide pigments or lakes for all CPC procedures.

We ask patients not to wear perfume on application day and to consume a light meal before application especially if they are going to take any pain medication. We always have soft, melodic music playing. Andrea Bocelli, Enya and Yanni have great soothing CD’s. Patients are given the choice of wearing a disposable gown or they may stay in their street clothes, depending on the procedure area and how extensive our application will be. We diffuse the room with essential oils that will consist of either orange or lavender for relaxation. Other oils that may be used for their sedating properties are sandalwood, chamomile or eucalyptus. These essential oils are absorbed through the lung tissue. For that special touch, offer the patient a calming blend of teas. We prefer Valerian Root Tea for its calming effect. Some technicians prefer to give their patients apple juice, or have them take a Motrin. You might also suggest a sublingual of Valerian Root and Kava Kava. (Technicians may not give patients any medication!) You may also offer your patient a headset or earplugs. Have the patient lie down and make them as comfortable as possible. In the cooler months, we wrap our patients in black sheets with their feet tucked in. We have had positive feedback from our patients that these small gestures help them to relax and feel secure.

Evaluate each area to be re-pigmented. Discuss color tones from the consultation application. Check your patient’s medical file and refer back to course of treatment from consultation day. Ask the patient if any information on their Procedure and Consent or Medical Forms has changed since their initial application. Before application, check patient for gradient skin tones. Inspect the procedure area to ensure there are no open lesions, rashes or other irregularities. To prepare the skin we cleanse the area with a sterile ‘Lid Wipe’. This product is a non-irritating scrub that will destroy bacteria and also remove any make-up left on the procedural area. Apply correct color. We usually wait until the 2nd or 3rd appointment to apply any nuances (ex. beard simulation, freckles, capillaries.) Adjust color if necessary.

Post-procedure appointments should be scheduled at 4-8 week intervals. The patient may return sooner if you are re-pigmenting various areas, but you cannot work on the same procedure area until it is completely healed. Touch-up appointments are critical for any fine detail work the patient may request, or to create any subtle additions or corrections in pigment color.

Informed and educated technicians understand specific needs of the patients.

C.P.C. is an advanced procedure and proper education is essential for satisfactory results.

Susan Church CCPC,CPDA
Director of Education
International Institute of Permanent Cosmetics
This article first appeared in the SPCP April/May 1996 Newsletter

For product information:

IIPC at 800.2820.577 or visit

Skin Needling, Melanocyte Restoration and Scar Relaxation

Melanocyte Restoration by Susan Church IIPCScar Relaxation


Susan Church first introduced Scar Relaxation to the world of permanent cosmetics at the inaugural SPCP (Society of Permanent Cosmetic Professionals) conference in 1991, after she discovered its benefits while working on several burn survivors in concert with Dr. Grossman. As you will see, this is a process that still presents huge developmental potential, even though our clinic has been utilizing these Scar Relaxation techniques since 1988.


















We have lectured many times on this subject and have had articles and photos featured in several publications over the years. Some of this exposure includes: lecturing at the Phoenix Burn Foundation’s National Burn Congress, for the Alicia Roush Burn Foundation and for Surviving Burns Support Services, plus published articles for Burn Survivors Througho512NCH0EA9L__SY300_ut The World, Inc. and The American Society of Esthetic Medicine Inc. You can also check out our chapter in the book, “Aesthetic Facial Restoration” by the world famous plastic surgeon and burn specialist Dr. Elliott H. Rose of Park Ave. in New York. This book was written for plastic surgeons to teach them to “utilize three-dimensional subtraction analysis to fashion vascularized bone grafts for microsurgical jaw and orbital rim reconstruction.”

Both Needling and Scar Relaxation are specific well-designed applications that help create supple skin texture for patients.

We consider both of these procedures to be held in the category of Corrective Pigment Camouflage, also known as C.P.C.

Needling, also known as ‘Skin Needling,’ is accomplished when the technician utilizes a certain technique while inserting the machine’s needle into the top layer of the epidermis. This method is best accomplished when it is used quite shallow in the skin.

Skin Needling (Melanocyte Restoration ) may reactivate the melanocytes in the skin. (See photos). We performed Skin Needling (Melanocyte Restoration) on an African-American client with hypo-pigmented skin and obtained beautiful results; the lighter spots re-pigmented where we performed the Melanocyte Restoration Skin Needling procedure to blend in with the rest of his skin. (See the end of this page for more information and photos on Skin Needling and Melanocyte Restoration.)

All photos are copyrighted



Patient prior to Melanocyte Restoration to reactivate the melanocytes in his skin.
Patient has hypo pigmented areas on his arms, chest and back.






Patient immediately following his Melanocyte Restoration procedure. We apply petroleum over the  procedural area to protect the skin from free  radicals. He noticed the pigment changing within the first few weeks after his initial needling application.







Patient 6 months following his Melanocyte Restoration procedure.
His skin tones now blend into each other more fluidly.
You do not notice the hypo pigmented areas as easily.
One year later his skin still looks good.




Scar Relaxation has a different purpose, as the technician needs to work deeper in the dermal layer to soften tough, fibrous bands of collagen, or scar tissue, to give the patient more flexibility and range in their movements. This procedure works well on all contractured tissue, with exceptional results on the hands. Because scar tissue is thick and extremely difficult to work with, a technician must penetrate their needle deeper into the skin to obtain lasting results for the client.

The technique for both Skin Needling and Scar Relaxation is the application of repetitive circular movements with the needle, called ‘obovoids.’

Skin Needling aka Collagen Rejuvenation Therapy (CRT) is primarily used to ‘plump’ up areas of the skin, and relies on the body’s natural healing response of sending collagen to the site of an inflammatory tissue injury. For example, when Skin Needling™, Collagen Rejuvenation Therapy™ is performed on wrinkles, the brain reads the needles penetration as an injury to the skin, therefore releasing collagen to the “injury” site and diminishing the wrinkles by plumping them.

Client prior to any CRT™application to plump out her fine lines.






Client 8 weeks post her first CRT™ application.
Client states her naso- labial folds (vertical lines between the nose and mouth) and the lines around her mouth have plumped up considerably. She loves her look and is ready for more treatment applications to plump up other areas on her face.



Scar Relaxation and Skin Needling appointments are usually scheduled at 4-week intervals. Dramatic results can be realized after the first treatment of either treatment.

Our patients are excited with the results of their Corrective Pigment Camouflage procedures. Many times, Scar Relaxation applications eliminate the need for repeated, painful surgeries on burn areas and contractured tissue – something we take great pride in.

The following is an excerpt from an article in a Newsletter in 1996:

“In all post procedure phases of C.P.C. there is an inflammatory response of the skins tissue. The skins typical symptoms may range from mild redness, heat, swelling and discomfort to lymph drainage. All patients will experience a typical wheal and flare reaction (redness, histamine release and swelling) to the procedure area that is much like a bee sting or mosquito bite. Applications of C.P.C. will also cause increased blood flow to the immediate area. The procedure area will be a bit sore, swell slightly to moderately within the first 24 hours, may be very tender and be slightly pink to red.

Immediate after care instructions includes the use of either petrolatum or some type of an antibiotic ointment. If possible, cover the area to keep it exempt from free radicals and pollution for 12-24 hours. If the procedure area is swollen, you may use ice for the first 24-72 hours to help alleviate the pain and swelling. Using heat after this period will promote circulation and discharge of waste products. Injured tissue will heal much faster and scar less if the patient keeps the area moist. The patient should apply a thin coating of petrolatum over the procedure area while showering or bathing to protect it from moisture.

Patients should never use their fingers to apply ointments or petrolatum to the procedural area. All products should be applied with a cotton swab or tissue.

Technicians need to be cautious of post-inflammatory hyperpigmentation (darkening of the tissue) when applying C.P.C. Hyper-pigmentation occurs when the skin’s tissue is traumatized. Hyper-pigmentation occurs in Caucasian skin occasionally, although it will most likely occur on clients with heavy concentrations of melanin in their skin. Normal skin color should return in several months following the application of C.P.C. Bleaching agents such as Hydroquinone, Kojic Acid and/or Licorice applied 1-2 times a day may be used to lighten the skin if needed.”

For more photos and information please go to:

The following photos show the effects of Corrective Pigment Camouflage as demonstrated by Scar Relaxation and Needling:

Susan Church CCPC, CPDA
Director of Education
Education Advisor for the SPCP 2004-2005
Director of Clinical Research and Development

©IIPC – This article has been reprinted.

Follow up post:

Collagen Rejuvenation Therapy is now used instead of the term Skin Needling

Corrective Pigment Camouflage: Part 1 of 3

Part I of a 3-part series.

This article will deal with the consultation of a burn patient.

Information will include: patient expectations, the ability to tolerate pain (pre-procedure sedation), consulting with the patient’s physician, pre-care and photos.

Our primary concern is to correct tissue color defects and create the illusion of smoother looking skin. Dr. Francis Cook MacGregor, a research scientist and member of the rehabilitation team at New York University Medical Center, states “In our culture the way one looks makes a difference in the response one gets. It is this fact that defines one’s identity because it defines the reaction of others.” The mouth is the second most noticed feature of the face, preceded only by the eyes. The disfigured face may be transformed by plastic /reconstructive surgery, corrective cosmetics or by Corrective Pigment Camouflage (CPC).

Patient assessment includes two phases: 1) collection and 2) analysis of information. This is achieved through the interview and examination. Most burn patients have lower self-esteem, social anxiety and fear of rejection. With this in mind, it is imperative to obtain information vital to your overall plan. The patient’s past and present medical records contain data helpful to your overall assessment. These records should include a complete medical history including allergies to food, anesthesia, drugs, chemicals, metals, etc., and any diseases or disorders (psychological or physical).

Take time to establish a rapport with the patient, identify their needs and agree on goals. Thoroughly discuss their perception of their present situation and what the CPC can do. They must be made aware this procedure is a multi-step process and final results cannot be determined until all applications are completed.

When a person initially phones you for a consultation, be sure to ask who their physician is and if they are presently under their care. If they take medication or plan surgery in the next few months, work in concert with their physician. This will serve a dual purpose: the patient will achieve better results due to your access to their complete medical history and the physician will be able to see your work firsthand, which may lead them to refer other patients to you.

The evaluation should include the use of glycolic or other acid prior to procedure day. This exfoliation/desquamation is the process of removing dead cells from the epidermis. This application will remove only dead tissue, not living tissue. Ask their treating physician if they should see a dermatologist to set up an exfoliation program. We know the cell renewal rate is generally every 21-28 days. For younger people it is 3-4 weeks, for middle age adults it is 4-7 weeks and a mature adult’s skin regenerates itself at a rate of 7-12 weeks or longer. This information is also vital when rescheduling your patient for their next appointment. The exfoliation process makes the skin more receptive to pigment retention.

Have the patient drink 8-10 glasses of water daily, as this hydrates the skin. Other considerations include: limiting intake of caffeine, sodium, aspirin and alcohol 3-5 days prior to each procedure.

Thoroughly discuss what is feasible for you to achieve with CPC. Show photos of other burn and scar work from onset to finish. Even though every case is different, this will enable them to see what can be achieved.

Write a detailed description of your treatment plan and go over it with the patient. Both of you must be in total agreement with all phases of CPC. Getting them involved in their treatment should help them have control over their life, get them excited about living again, and give them confidence.

Use a good quality camera for clear, distinct photographs. I use both a Pentax IQ Zoom 900 and a 700 with a macro lens, and a Polaroid camera. The cost of these cameras is around $300-$400. We prefer Kodak or Fuji film with a speed of 200-400 or more. Take pictures from 12 inches, 2 and 3 feet away, as well as a full body shot. These photos will be crucial in developing your overall plan of assessment for CPC. Photograph the patient’s areas of concern and mark the areas. Place patch color tests in marked areas. This will be your guide for future pigment application. Always have visible proof of your work as documentation for any and all interested parties. This may include physicians, worker’s compensation cases, insurance companies, attorneys, technicians and others.

Most burn patients have been through numerous surgeries and they are either oblivious to pain during procedures or the pain is very intense. We use a topical anesthesia to reduce the pain. We have found the best anesthesia to be ULTRAcaine White by IIPC, first applied and then wrapped in an occlusive dressing. Anesthesia is applied 1/2-1 1/2 hours prior to procedure application. We also use 1-2 drops of Numit liquid anesthesia in our pigments.


  • Never ask a patient the details of how they were burned.
  • An examination of facial morphology and symmetry is crucial.
  • Touching your patient will communicate safety and security.
Written by Susan Church CCPC
Director of Education
International Institute of Permanent Cosmetics
This article first appeared in the SPCP Jan./Feb. 1996 Newsletter
Note: We use the word “client” to refer to people we perform permanent cosmetic application on; We use the word “patient” to refer to people that have been referred to us by physicians. Corrective Pigment Camouflage is a most advanced procedure and should only be undertaken by experienced and trained permanent colour technicians.

For product information on ULTRAcaine White and NUMIT LIQUID phone


or visit

Q and A: An Interview with Ms. Susan Church

The following is an interview of Ms. Susan Church conducted by Michelle Lauren.

Michelle Lauren: What is your favorite procedure to perform?


Susan Church: Areola Restoration. The combination of anatomy and art in this procedure is intriguing. Blending these two components to “re-manufacture” nipple and areola configurations, while producing life-like results, is fascinating for me and emotionally satisfying for the patient.

ML: What is the best part of your job?

SC: My greatest satisfaction comes from my work with children who suffer from Alopecia, Vitiligo, and Burn or Cancer scarring. I am pleased and willing to help the physical and emotional scaring that children have endured from their maladies.

I perform these procedures pro-bono. It’s my way of giving back to the community and to help repair a child’s self-esteem. Their smile is all the reward that I need.

ML: What is the worst part?

SC: The worst part is when I’m unable to help someone in need from crisis. It saddens me when I am not able to do a procedure due to an accelerated condition.

ML: You talk about Karma and giving back to society. Can you explain?

SC: Karma is a boomerang! The more good that I do, the more good comes back.

ML: Do you prefer to educate or do the actual procedures?

SC: I love performing the actual procedures; however, my procedural beginning brought me to the level of instruction. I have such great passion for this art form, and the industry, that society deserves to have the most informed and professional technicians available.

ML: I noticed that many schools have used part of your name, what do you think about this?

SC: Well, they say that “imitation is the sincerest form of flattery.” Sometimes I feel as if people are stealing from me out-right. It would be comforting, at least, to be acknowledged by identification.

On numerous occasions my work has been copied right down to the grammatical and punctuation errors. Photos have shown up in lectures with my logo on them, or on the websites or class information of other technicians and educators. To not give credit where credit is due is unethical.

ML: Does that affect your attitude?

SC: It doesn’t have any bearing on my demeanor or my ethics. My work supports every one of my achievements. My pride supports my accomplishments. My protocol supports my ethics. I respect the rights of my clients.

ML: Can you name any celebrities you’ve had as clients?

SC: Excuse me. Didn’t you listen to my answer to your last question? (laughing) The children I perform procedures on are now my celebrities.

ML: Have your students worked on celebrities?

SC: Yes, I know many of them have worked on celebrities, as they’ve needed to ask me technical questions regarding the procedure.

Some celebrities tell the technician it is OK to tell me who they are working on. And no…I cannot tell you who they are! (laughing). But you see them in the magazines and tabloids every week.

ML: What prompted you to co-found a Society?

SC: It was the need for a level of competency among all technicians. Neophytes were trying to teach other neophytes. We also wanted a code of ethics that every member had to sign and live by. This would help to ensure that they would at least think about an answer before speaking.

Also, There were many companies selling inferior products and machines that caused cross contamination. We felt it was our responsibility to hold them accountable.

ML: Having invested your entire adult life to this industry, have you reached fulfillment?

SC: I have been in the direct beauty industry since high school. However, I used to help my two aunts in their salon when I was in grade school. I would take nail polish off of the client’s nails, take rollers out of their hair, sweep the hair off of the floor, and many other duties that I considered interesting. Their passion for their clients was amazing and I guess I received part of their family genes.

After so many years in the tattoo industry, every day still brings a new challenge to me. Whether it is helping the State Boards of Health, medical professionals, cancer patients, or the new or veteran technician that may have a question. In that respect, I suppose I feel fulfilled every day.

ML: If you weren’t’ performing permanent cosmetic procedures at IIPC what would you have liked to be doing?

SC: I am virtually doing exactly what I want to do on a daily basis. But, it would be nice to be able to write more.

ML: You have written several educational books and have produced many DVD’s as well. What’s next?

SC: When I can squeeze in the time I am also in the process of writing two other books that have nothing to do with permanent cosmetics. And no, I cannot divulge what they are about just yet, but they will be very entertaining!